The emergency department (ED) is synonymous with chaos, confusion, and unrest. As emergency physicians (EP), we thrive in this mayhem and as our experience widens, we find our method to this perceived pandemonium. Blood, vomitus, and beeping monitors, all fade into the background as our attention remains focused only on the patient in front of us and we do the best we can for them. In our zone of familiarity with the well-known faces of colleagues, nurses, and students, we find ourselves swiftly switching our cerebral gears through history/exams/laboratory reports/scans/diagnosis/procedures, but we seldom halt to understand the practical implications of those on the feelings of the patient and their families who await a few words of kindness and hope from us in this unnerving environment.
Patients and families coming to the ED are usually having the worst day of their lives! The article “Factors affecting stress levels in attendants accompanying patients to Emergency Department ”demonstrates this fact as nearly 98% of attenders were found to have some form of stress. Attendants accompanying critically ill patients, with no previous ED experience, unmarried, in the middle age group, female gender, first-degree relatives, perceiving long waiting time, and dissatisfied with treatment were at significant risk of developing high stress. A passing gaze on these factors may lead you to ponder, “but what can I do about it?” Moreover, we do partly agree with that sentiment. As an EP immersed in the chaos, seeing multiple patients at once, juggling life-threatening diagnoses and keeping up with documentation, all this feels like a losing battle.
However, one of the standout professional factors that lead to patient dissatisfaction eventually, leading to aggression (verbal or physical), is lack of communication. Data from an Indian study evaluating workplace violence reported that only 6 of 151 participants received formal training in effective communication. A survey of surgical residents across four medical colleges reported that 81.7% did not receive any training in communication skills, and in emergency surgeries, 32% of the residents spent less than 1 min conversing with their families. Ineffective communication can lead to a lack of understanding of disease process and result in disproportionate expectations from the given clinical scenario by the family. There is a glaring need for the implementation of communication teaching in our curriculum, which should focus on empowering students with desirable communication skills to diffuse situations and develop an empathetic approach to our patients. Considering this, the National Medical Commission (NMC) has made attitude, ethics, and communication skills modules a mandatory part of undergraduate learning, which is a step in the right direction.
There is no denying that sweeping administrative changes are needed at government and institutional levels as well. Policy changes in hospitals such as preventing overcrowding within the department, availability of health-care workers or social workers to help smoothen operational delays, and increasing security will go a long way. Effective legislation against violence and a better health budget will help hospitals cope with the unprecedented surge of patients at the ED.
As an EP, what is routine for us, is bizarre and life-changing for patients and their families. Utilization of AIDET (Acknowledge the patient, Introduce yourself, Duration – of stay/labs/procedures (always overestimate!) Empathy and Explanation – what's happening and what's next and Thank you, is one such structured framework for communication that will help make an impact. Communication with compassion is paramount and, unlike popular belief, does not take too much time.
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5. National Medical Commission. Competency Based Undergraduate Curriculum.[Last accessed on 2022 Sep 12] Available from: https://www.nmc.org.in/information-desk/for-colleges/ug-curriculum